Healthcare Provider Details

I. General information

NPI: 1427481266
Provider Name (Legal Business Name): ANSH YOGESH DESAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HANCOCK ST STE 205
QUINCY MA
02171-2442
US

IV. Provider business mailing address

468 ELM ST E
RAYNHAM MA
02767-1827
US

V. Phone/Fax

Practice location:
  • Phone: 173-280-7906
  • Fax:
Mailing address:
  • Phone: 617-306-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856380
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN03198
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: